# CPT 43239: Upper GI endoscopy with biopsy

Medicare CPT 43239 pays $418.85 in a non-facility setting and $123.58 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $367.66 in Arkansas to $483.17 in District of Columbia, a 31% spread.

Web page: https://www.med-reveal.com/rates/43239-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology, General Surgery

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $418.85 |
| National facility | $123.58 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| District of Columbia | $483.17 | $135.34 |
| California | $478.36 | $128.98 |
| Alaska | $475.29 | $160.83 |
| Washington | $465.88 | $129.28 |
| New Jersey | $465.43 | $132.96 |
| New York | $464.16 | $134.76 |
| Massachusetts | $460.66 | $128.93 |
| Hawaii | $460.54 | $124.82 |
| Connecticut | $447.86 | $129.86 |
| Colorado | $439.05 | $124.89 |
| Oregon | $434.74 | $123.68 |
| Maryland | $434.67 | $126.86 |
| New Hampshire | $431.33 | $123.96 |
| Rhode Island | $430.31 | $125.30 |
| Florida | $428.49 | $132.24 |
| Puerto Rico | $422.36 | $123.85 |
| Virgin Islands | $422.36 | $123.85 |
| Minnesota | $422.13 | $118.30 |
| Montana | $418.83 | $123.57 |
| Nevada | $417.67 | $122.11 |
| Wyoming | $416.50 | $121.24 |
| Illinois | $416.13 | $130.83 |
| Delaware | $414.34 | $122.62 |
| North Dakota | $413.49 | $118.23 |
| Texas | $413.49 | $122.80 |
| Pennsylvania | $413.37 | $124.15 |
| South Dakota | $412.86 | $117.60 |
| Vermont | $411.07 | $118.76 |
| Virginia | $410.55 | $120.31 |
| Arizona | $407.26 | $121.15 |
| Georgia | $405.47 | $123.79 |
| Michigan | $402.27 | $125.01 |
| Maine | $400.71 | $118.58 |
| Wisconsin | $398.66 | $115.80 |
| Utah | $398.01 | $120.46 |
| North Carolina | $393.35 | $117.87 |
| New Mexico | $393.10 | $122.35 |
| South Carolina | $392.26 | $119.44 |
| Missouri | $391.37 | $120.42 |
| Louisiana | $390.39 | $120.81 |
| Ohio | $390.04 | $120.46 |
| Indiana | $389.98 | $116.27 |
| Nebraska | $387.67 | $115.14 |
| Idaho | $387.53 | $115.89 |
| Iowa | $385.19 | $115.02 |
| Tennessee | $384.46 | $116.06 |
| Kansas | $382.50 | $115.58 |
| Oklahoma | $381.31 | $117.64 |
| Kentucky | $381.23 | $118.74 |
| West Virginia | $379.24 | $122.66 |
| Alabama | $373.43 | $115.08 |
| Mississippi | $370.34 | $116.12 |
| Arkansas | $367.66 | $114.03 |

## Related codes

- 40490: Biopsy of lip — https://www.med-reveal.com/rates/40490-cpt-fee-schedule
- 40650: Repair lip, vermilion only — https://www.med-reveal.com/rates/40650-cpt-fee-schedule
- 41010: Frenotomy, lingual — https://www.med-reveal.com/rates/41010-cpt-fee-schedule
- 41112: Excision of lesion of tongue — https://www.med-reveal.com/rates/41112-cpt-fee-schedule
- 41599: Unlisted procedure, tongue/floor of mouth — https://www.med-reveal.com/rates/41599-cpt-fee-schedule
- 42700: Incision and drainage of peritonsillar abscess — https://www.med-reveal.com/rates/42700-cpt-fee-schedule
- 42820: Tonsillectomy and adenoidectomy, under age 12 — https://www.med-reveal.com/rates/42820-cpt-fee-schedule
- 42821: Tonsillectomy and adenoidectomy, age 12 or over — https://www.med-reveal.com/rates/42821-cpt-fee-schedule

Commercial negotiated rates for 43239 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules